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A decade ago, the Society of Prevention Research (SPR) endorsed a set of standards for evidence related to research on prevention interventions. These standards (Flay et al., Prevention Science 6:151–175, 2005 ) were intended in part to increase consistency in reviews of prevention research that often generated disparate lists of effective interventions due to the application of different standards for what was considered to be necessary to demonstrate effectiveness. In 2013, SPR’s Board of Directors decided that the field has progressed sufficiently to warrant a review and, if necessary, publication of “the next generation” of standards of evidence. The Board convened a committee to review and update the standards. This article reports on the results of this committee’s deliberations, summarizing changes made to the earlier standards and explaining the rationale for each change. The SPR Board of Directors endorses “The Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research in Prevention Science: Next Generation.”

Background.The psychological effects of war trauma are well-documented, but comparatively little research has focused on the mechanisms underlying intergenerational impacts of war and displacement. Specifically, the effects of armed conflict on family processes such as parenting behavior, and subsequent impacts on child psychosocial outcomes, are less understood.Methods.This study tests a conceptual model linking past war trauma and current displacement-related stressors to maternal mental health, parenting behavior, and child psychosocial problems. Cross-sectional data were collected in 2016–2017 from a sample of 291 Syrian refugee mothers in Lebanon. We used structural equation modeling to examine associations between war trauma, daily stressors, mothers’ general psychological distress and post-traumatic stress (PTS), negative parenting, and child psychosocial problems.Results.Exposure to war-related events was directly associated with maternal PTS and general psychological distress, as well as indirectly via daily stressors. Mothers’ general psychological distress, but not PTS, was directly associated with negative parenting and child psychosocial difficulties. Negative parenting mediated the association between maternal general psychological distress and child psychosocial problems. Model fit statistics indicate that the measurement and structural models provided a good fit to the data.Conclusions.Results suggest that the adverse effects of past war trauma and ongoing displacement on refugee mothers’ general mental health can increase the risk of negative parenting behavior, and in turn contribute to poorer psychosocial outcomes for children. Interventions should focus on psychosocial and parenting support for war-affected caregivers, as well as address structural challenges that debilitate caregiver and child mental health.

Background Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes. Methods The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers ( n  = 5), practitioners ( n  = 5), and local community organisations ( n  = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships ( n  = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement. Results Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content. Conclusions This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.

What are the parenting behaviors that shape child compliance? Most research on parent-child interactions relies on correlational research or evaluations of \"package deal\" interventions that manipulate many aspects of parenting at the same time. Neither approach allows for identifying the specific parenting behaviors that shape child compliance. To overcome this, we systematically reviewed and meta-analyzed available evidence on the effects of experimentally manipulated, discrete parenting behaviors-a niche in parent-child interaction research that contributes unique information on the specific parenting behaviors that shape child behavior. We identified studies by systematically searching databases and through contacting experts. Nineteen studies (75 effect sizes) on four discrete parenting behaviors were included: praise, verbal reprimands, time-out, and ignore. In multilevel models, we tested for each parenting behavior whether it increased child compliance, including both observed and parent-reported measures of child compliance. Providing \"time-out\" for noncompliance robustly increased both observed and parent-reported child compliance (ds = 0.84-1.72; 95% CI 0.30 to 2.54). The same holds for briefly ignoring the child after non-compliance (ds = 0.36-1.77; 95% CI 0.04 to 2.90). When observed and parent-reported outcomes were combined, but not when they were examined separately, verbal reprimands also increased child compliance (d = 0.72; 95% CI 0.26 to 1.19). Praise did not increase child compliance (ds = -0.27-1.19; 95% CI -2.04 to 1.59). Our findings suggest that of the discrete parenting behaviors that are experimentally studied in multiple trials, especially time-out and ignore, and to some extent verbal reprimands, shape child compliance.

Developing a better understanding of sources and mechanisms of heterogeneity is a key route to improving outcomes and targeting of preventive interventions. This commentary attempts to draw together findings from eight intervention trials in this special issue, each exploring baseline target moderation (BTM) or baseline target moderated mediation (BTMM). It considers their implications for prevention research and program design, particularly the question of whether they can help us to revise or adapt interventions. The studies cover a range of interventions, targets, and contexts, including parenting, couple, and CBT interventions, for depression, anxiety, conduct problems, or obesity. Some important findings stand out. Where studies found moderator effects, they tended to operate in a “compensatory” fashion, such that greater benefit was found in higher risk groups, suggesting that closer targeting might be warranted. It was rare for harmful effects to be detected for any subgroups. In other respects, patterns of BTM/BTMM findings were quite mixed across studies, suggesting it would be premature to change our interventions based on these trials. Implications of the findings for equity, for “slimming down” and scaling up interventions, and for research are discussed, including the need to combine BTMM with intervention component research, and to accumulate a more robust body of evidence by pooling data across trials.

Background This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators. Method Sixty primary caregivers of children aged 2–9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman’s ANOVA, and thematic analysis. Results Participants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment ( d  = − 0.58, p  < 0.001), as well as reductions in physical ( d  = − 0.58, p  < 0.001) and emotional abuse ( d  = − 0.40, p  < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting ( d  = − 0.52, p  < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress. Conclusions This study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results. Trial registration 11/01/2019, ClinicalTrials.gov, ID# NCT03539341 .

Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. The current study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program. Families with toddlers between ages 2 and 3 were screened and then randomized to a brief family intervention, the Family Check-Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention services were provided at age 3 and follow-up of child outcomes occurred at ages 3 and 4. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. The results are discussed with respect to targeting maternal depression in future intervention studies aimed at improving early child problem behavior.

Background Development of guidelines for public health, health system, and health policy interventions demands complex systems thinking to understand direct and indirect effects of interventions within dynamic systems. The WHO-INTEGRATE framework, an evidence-to-decision framework rooted in the norms and values of the World Health Organization (WHO), provides a structured method to assess complexities in guidelines systematically, such as the balance of an intervention’s health benefits and harms and their human rights and socio-cultural acceptability. This paper provides a worked example of the application of the WHO-INTEGRATE framework in developing the WHO guidelines on parenting interventions to prevent child maltreatment, and shares reflective insights regarding the value added, challenges encountered, and lessons learnt. Methods The methodological approach comprised describing the intended step-by-step application of the WHO-INTEGRATE framework and gaining reflective insights from introspective sessions within the core team guiding the development of the WHO guidelines on parenting interventions and a methodological workshop. Results The WHO-INTEGRATE framework was used throughout the guideline development process. It facilitated reflective deliberation across a broad range of decision criteria and system-level aspects in the following steps: (1) scoping the guideline and defining stakeholder engagement, (2) prioritising WHO-INTEGRATE sub-criteria and guideline outcomes, (3) using research evidence to inform WHO-INTEGRATE criteria, and (4) developing and presenting recommendations informed by WHO-INTEGRATE criteria. Despite the value added, challenges, such as substantial time investment required, broad scope of prioritised sub-criteria, integration across diverse criteria, and sources of evidence and translation of insights into concise formats, were encountered. Conclusions Application of the WHO-INTEGRATE framework was crucial in the integration of effectiveness evidence with insights into implementation and broader implications of parenting interventions, extending beyond health benefits and harms considerations and fostering a whole-of-society-perspective. The evidence reviews for prioritised WHO-INTEGRATE sub-criteria were instrumental in guiding guideline development group discussions, informing recommendations and clarifying uncertainties. This experience offers important lessons for future guideline panels and guideline methodologists using the WHO-INTEGRATE framework.

Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting). This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes. This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included. Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings. This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being.